Hospital-Based Prevalence, Electroencephalogram (EEG), and Neuroimaging Correlation in Seizures Among Children in Odisha, India.

BACKGROUND: Febrile seizures are very common in pediatric practice. We need to differentiate between febrile seizures and other seizures due to central nervous system (CNS) infection by various means of investigation. Though approximately 30% of patients with febrile seizure have later epilepsy and the risk is around 20% even if electroencephalogram (EEG), and neuro-imagings are normal. But data regarding this is laking in developing countries like India. AIM: The primary objective of this study is to determine the hospital-based prevalence among various types and etiologies of seizures in children admitted to the pediatric department in a teaching hospital of a developing country, India. Besides, the different types of seizures were correlated with the EEG and neuroimaging findings along with the acute onset of seizures among children. METHODS: In this prospective observational study, children from two months to 15 years of age admitted to the Pediatrics Department, KIMS, Bhubaneswar in India between September 2017 and September 2019 were taken. The patients having seizures were included in the study based on the inclusion criteria. Neurological and systemic examinations of the children were recorded and the neuroimaging reports were analyzed. RESULTS: A total of 19,553 patients aged two months to 15 years were admitted during the study period. Of that, 1,192 cases were diagnosed with febrile and unprovoked seizures. It was observed that the hospital-based prevalence of seizures among children in Odisha was 6%. Besides, it is found that generalized seizure disorder was the most common among the children. It was found that abnormal EEG, magnetic resonance imaging (MRI), and computed tomography (CT) brain in 60% (202/340), 49% (113/230), and 47% (136/288) of cases, respectively. MRI is a better modality of investigation in partial seizure cases 22 (64%) to detect CNS abnormality. Also, MRI of the brain is better in evaluating CNS abnormality in complex febrile cases 4 (31%) than CT brain (0%). CONCLUSION: The study concluded that EEG must be the standard modality of test for patients' diagnosis of seizure in children with seizures. CT/MRI scan can give a better supplement to the results but MRI findings are more accurate in cases of complex febrile seizures.

A Comparison Between Transcutaneous Bilirubin and Total Serum Bilirubin Levels for the Management of Jaundice in Preterm Neonates by Bland-Altman Plot.

Objective To compare the bilirubin levels measured by transcutaneous bilirubinometer and serum samples for the management of jaundice in preterm neonates. Methods The study was a prospective comparative observational study conducted in a tertiary care neonatal unit of Odisha from January 2019 to June 2020. All inborn and outborn neonates with a gestational age of 280/7 weeks to 366/7 weeks with the clinical diagnosis of neonatal jaundice were included in the study. Transcutaneous bilirubin (TcB) was estimated by Dragger jaundice meter JM-105 and simultaneously venous blood and total serum bilirubin levels (TSB) were measured by diazonium method. The comparison between TcB and TSB values was analyzed by direct linear correlation in scatter plot and Bland-Altman plot. Results A total of 167 preterm neonates (66, 28-336/7 and 111, 34-366/7), with a mean gestational age 33.55 ±2.36 weeks and a mean birth weight of 1960 ± 613 grams, were analyzed. The mean TSB and TcB levels were 12.99 ± 3.47 mg/dl (min-max 4.9-18.3 mg/dl) and 14.156 ± 4.71 mg/dl (min-max 4-20.1 mg/dL), respectively. The TcB is excellently correlated with TSB with a correlation coefficient of r =0.948, p ≤0.001. The bias difference between TcB and TSB is -1.16 (95% CI: 2.35, -4.6) mg/dl. The correlation coefficients between 28-336/7 weeks gestational age groups (r = 0.944) and 34-366/7gestational age (r = 0.950) were similar. Conclusion TcB is well correlated with TSB level in preterm neonates. Hence, TcB can be used for the guidance of management in these neonates.

Insights into Plasmodium and SARS-CoV-2 co-infection driven neurological manifestations.

In malaria-endemic regions, people often get exposed to various pathogens simultaneously, generating co-infection scenarios. In such scenarios, overlapping symptoms pose serious diagnostic challenges. The delayed diagnosis may lead to an increase in disease severity and catastrophic events. Recent coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has affected various areas globally, including malaria-endemic regions. The Plasmodium and SARS-CoV-2 co-infection and its effect on health are yet unexplored. We present a case report of a previously healthy, middle-aged individual from the malaria-endemic area who suffered SARS-CoV-2 and Plasmodium falciparum co-infection. The patient developed severe disease indications in a short time period. The patient showed neurological symptoms, altered hematological as well as liver-test parameters, and subsequent death in a narrow time span. We hereby discuss the various aspects of this case regarding treatment and hematological parameters. Further, we have put forward perspectives related to the mechanism behind severity and neurological symptoms in this fatal parasite-virus co-infection case. In malaria-endemic regions, due to overlapping symptoms, suspected COVID-19 patients should also be monitored for diagnosis of malaria without any delay. The SARS-CoV-2 and Plasmodium co-infection could increase the disease severity in a short time span. In treatment, dexamethasone may not help in severe cases having malaria as well as COVID-19 positive status and needs further exploration.